Download Benefits of rehabilitation programs for the asthmatic patient

Palestrica of the third millennium – Civilization and Sport
Vol. 16, no. 3, July-September 2015, 269–275
Benefits of rehabilitation programs for the asthmatic patient
Beneficiile programului de reabilitare în astm
Rodica Trăistaru 1, Diana Kamal 1, Mara Bălteanu 2, Taina Avramescu 3
1
University of Medicine and Pharmacy of Craiova
2
University Titu Maiorescu, Bucharest
3
University of Craiova, Faculty of Sport and Kinetotherapy
Abstract
Asthma is among the most important problems of medicine and is one of the most frequent chronic respiratory diseases. It
is characterized by recurrent attacks of shortness of breath and wheezing, which vary from person to person. After a few years
of treatment with medication, the patients with asthma have dysfunctions and disabilities. There is a real need of additional,
non-drug remedies that can affect the basic clinical manifestations of the disease to improve the efficiency of treatment of such
patients and reduce the drug load. The main goal of the rehabilitation treatment of asthma (allergic and non-allergic asthma,
but also late onset asthma and asthma with fixed airflow limitation) is to restore the homeostatic self-regulation of the body
and consists of many methods such as education, postural drainage, respiratory gymnastics, physical training, climatotherapy,
speleotherapy, halotherapy, balneotherapy, and even spa treatment.
Key words: asthma, treatment, rehabilitation.
Rezumat
Astmul reprezintă una dintre cele mai frecvente afecţiuni cronice ale sistemului respirator şi una din provocările lumii
medicale curente. Se caracterizează prin atacuri recurente de dispnee, wheezing, variabile de la persoană la persoană. După
ani de tratament medicamentos, pacientul astmatic prezintă o disfuncţie/dizabilitate variabilă. Sunt necesare remedii nonfarmacologice (programe de reabilitare), care să controleze manifestările clinice şi să reducă disfuncţia/dizabilitatea pacientului,
cu limitarea necesarului de medicamente. Scopul principal al programului de reabilitare la oricare pacient astmatic este de a
reface starea de homeostazie a individului, cu capacitatea de self-control şi constă în mai multe metode (program educaţional,
drenaj postural, gimnastică respiratorie, antrenament fizic, climatoterapie, balneoterapie, speleoterapie şi terapie inhalatorie,
tratament de tip spa).
Cuvinte cheie: astm, tratament, reabilitare.
Introduction
Asthma is among the most important problems of
medicine and is one of the most frequent chronic diseases
of the respiratory organs. The health and socio-economic
relevance of the problem is determined by further growth
of the morbidity rate, difficulty in control over the process,
increasing mortality, the high material damage to society
(***, 2007).
Global Strategy for Asthma Management and
Prevention, elaborated by Global Initiative for Asthma
(GINA) and updated in 2015, defines asthma as a
”heterogeneous disease with chronic airway inflammation,
history of wheeze, shortness of breath, chest tightness
and cough that vary over time in intensity and variable
expiratory airflow limitation”. These variations are
triggered by allergens, irritant exposures, exercises,
weather changes, viral respiratory infections (1).
Asthma symptoms can be resolved spontaneously
or by medication, and they can also be absent for a long
time (weeks or months). Another problem is the recurrent
attacks of shortness of breath and wheezing, which vary
in severity and frequency from person to person. These
conditions are due to the inflammation of the air passages
in the lungs and affect the sensitivity of the nerve endings
in the airways, so they become easily irritated. During
an attack, the lining of the passages swells, causing the
airways to narrow and reduce the flow of air in and out
of the lungs. The airways become narrow and swell and
produce extra mucus. This can make breathing difficult and
trigger coughing, wheezing and shortness of breath (***,
2007); (Clark & Rees, 1998).
Asthma affects all age groups but often starts in
childhood. For some people, asthma is a minor nuisance.
For others, it can be a major problem that interferes with
daily activities and may lead to a life-threatening asthma
attack. Asthma is a major burden on the individual patient
Received: 2015, June 1; Accepted for publication: 2015, June 22;
Address for correspondence: University of Medicine and Pharmacy of Craiova, No 2-4, Petru Rareş Str, Craiova, 200349, Romania
E-mail: [email protected]
Corresponding author: Rodica Trăistaru, [email protected]
Copyright © 2010 by “Iuliu Haţieganu” University of Medicine and Pharmacy Publishing
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Rodica Traistaru et al.
and society. People with asthma have been reported to
have lower levels of physical fitness, increased levels of
psychological distress and reduced health-related quality
of life (HRQoL), as well as school and work impairment
(Holland et al., 2013).
Epidemiology
Asthma affects an estimated 300 million individuals
worldwide. Annually, the World Health Organization has
estimated that 15 million disability-adjusted life-years are
lost and 250000 asthma deaths are reported worldwide
(Eder et al., 2006).
The prevalence rate of asthma in industrialized countries
ranges between 2-10%, but it depends on the state of the
environment and anthropogenic activity. Trends suggest an
increase in both the prevalence and morbidity of asthma,
especially in children younger than 6 years. Factors that
have been implicated include urbanization, air pollution,
passive smoking, and change in exposure to environmental
allergens (Clark & Rees, 1998; Eder et al., 2006).
Asthma predominantly occurs in boys in childhood,
with a male-to-female ratio of 2:1 until puberty, when the
male-to-female ratio becomes 1:1. Asthma prevalence is
increased in very young and very old persons because of
airway responsiveness and lower levels of lung function.
Two thirds of all asthma cases are diagnosed before the
patient is aged 18 years. Approximately half of all children
diagnosed with asthma have a decrease or disappearance of
symptoms by early adulthood (Clark & Rees, 1998).
Etiology
Many asthma phenotypes have been described. The
most common are:
- Allergic asthma with onset in childhood; patients
have a positive family history and present positive skin tests
to common allergens, allergic diseases such as eczema,
allergic rhinitis, food or drug allergy. The precipitating
factors can be easily detected in these patients (Cohn et
al., 2004; Holgate & Polosa, 2006). Eosinophilic airway
inflammation has good response to inhaled corticosteroid
(ICS) treatment (1). In allergic asthma, the precipitating
factors include: infection, house dust mites, pollens,
animals, exercise, smoking, dust and pollution, drugs,
foods, occupation, psychological factors, pregnancy and
menstruation, gastro-oesophageal reflux, thyroid disease
(Clark & Rees, 1998; Cohn et al., 2004).
- Non-allergic asthma diagnosed in adulthood,
airway inflammation with eosinophils and neutrophils;
this phenotype responds less well to ICS treatment
(1); it presents persistent symptoms, it has no obvious
precipitating factors, except infection, and the patients
have negative skin tests (Clark & Rees, 1998; Holgate &
Polosa, 2006).
- Late-onset asthma, with onset in adult life,
particularly in women, without allergy. These patients
require high doses of ICS or they are relatively refractory
to corticosteroid treatment (1).
- Asthma with fixed airflow limitation: some patients
with long-standing asthma develop fixed airflow limitation,
due to the airway wall remodelling process.
- Asthma with obesity (1).
Pathology
The three main factors producing airflow obstruction
in asthma are: the retention of bronchial secretions,
thickening of the bronchial wall and bronchoconstriction
(Clark & Rees, 1998); (***, 2007). Mucus in asthma is
abnormally sticky and also has an inhibitory action on
the cilia in the airways, both factors predisposing to
mucus retention and plugging. The bronchial wall is also
abnormal. Inflammatory cells, particularly eosinophils,
invade the wall, which becomes oedematous. Between
exacerbations these changes are reversible, but in the
longer term bronchial mucous glands may enlarge, and
bronchial smooth muscles and collagen beneath the
basement membrane may become thick (Cohn et al., 2004;
(***, 2007); Ohta et al., 2014). There may be an increase
in the collagen laid down beneath the basement membrane,
inducing sub-basement membrane fibrosis. This causes a
remodelling of the airways with irreversible obstruction.
The main physiological finding in asthma is airflow
obstruction. The immunohistopathological features of
asthma include inflammatory cell infiltration: neutrophils,
eosinophils, lymphocytes, mast cell activation, epithelial
cell injury (Clark & Rees, 1998; Holgate & Polosa, 2006,
Ohta et al., 2014).
Treatment
The GINA report established the long term goals
of asthma management to be the achievement of good
symptom control and minimisation of future risk of
exacerbations, fixed airflow limitation and side effects of
treatment; also, the patients’ own goals regarding their
asthma and its treatment should be identified (1). For all the
affected patients, the ultimate goal is to prevent functional
and psychological morbidity to provide a healthy (or near
healthy) lifestyle.
Pharmacological treatment of asthma covers controller
medication (used for regular maintenance treatment to
reduce airway inflammation and control symptoms in
order to reduce future risks) and reliever medication (used
during exacerbations). Add-on therapies can be considered
when patients have persistent symptoms and exacerbations
despite correct controller treatment (correct doses and
correct administration of medication).
A stepwise approach of asthma in order to control
symptoms and minimise future risks assumes the use of
control agents such as inhaled corticosteroids (budesonide,
beclomethasone dipropionate, fluticasone propionate,
ciclesonide, mometasone propionate) in all control steps
of asthma but in increasing doses, or/plus leukotriene
receptor antagonists (montelukast, zafirlukast) or/
plus low doses of theophylline for step 2, long-acting
beta agonist bronchodilators (LABA: formoterol,
salbutamol, indacaterol) for steps 3, 4, 5, ultra-longacting anticholinergic bronchodilators (tiotropium) in
steps 4 and 5, and more recent strategies such as the use
of anti-immunoglobulin E (IgE) antibodies (omalizumab)
in step 5 of asthma treatment (***, 2007); (Incorvaia &
Ridolo, 2015); (1). Relief medications include short-acting
bronchodilators (SABA: salbutamol, ipratropium bromide),
systemic corticosteroids (prednisone, methylprednisolone),
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Benefits of rehabilitation programs for the asthmatic patient
and low doses of inhaled corticosteroids/formoterol (Clark
& Rees, 1998; Holgate & Polosa, 2006; Bateman et al.,
2008); (1).
Despite the wide introduction in practice of documents
regulating the principles of treatment and prevention
of asthma, more than 80% of persons have a poor or
bad disease control, clinical symptoms and a need for β
2-agonists. In addition, there is often a failure in patients
that use hormonal drugs (***, 2007); (Lommatzsch &
Virchow, 2014). GINA updated the strategies for asthma
managment based on the individualization of treatment
depending on patient characteristics, modifiable risk
factors, patient preferences and practical issues (1).
Treatment of asthma exacerbations with medication is
effective in cases of emergency. However, this treatment
does not eliminate the cause of the disease: after a temporary
physical alleviation, the next acute exacerbation of asthma
is still inevitable, becoming more and more severe (Clark
& Rees, 1998); (***, 2007); Bateman et al., 2008).
Moreover, each year of treatment of asthma with
medication makes recovery difficult, as the use of drugs
increases damage to the epithelium of the airways at
cellular level, weakens the immune system as a whole and
reduces the parenchyma of the lung tissue, that is the area
of the lungs which is capable of gas exchange (Holgate &
Polosa, 2006); (***, 2007).
After a few years of treatment with medications, patients
with asthma have various dysfunctions and disabilities. As
such, their quality of life and life expectancy is on average
much lower than in healthy people. Comprehensive care
involves not only using drugs, but also non-pharmacological
treatment (Burianova et al., 2008). There is a real need of
additional, in particular non-drug remedies that can affect
the basic clinical manifestations of the disease to improve
the efficiency of treatment of such patients and reduce the
drug load (***, 2007); (Clark & Rees, 1998; Holgate &
Polosa, 2006; Bateman et al., 2008). GINA recommends, in
addition to pharmacological treatments, a few strategies in
the management of asthma; physical activity and breathing
exercises are two of these strategies (1).
Rehabilitation program
The holistic approach - In an attempt to develop
alternative therapies for asthma, a complex holistic
systemic therapy was proposed. This was aimed at
the systemic restoration of the immune system, blood
microcirculation and treatment of stress. It began with
a complex systemic diagnosis of patients with asthma
that included: determining the condition of the body
homeostatic self-regulation, identifying the type of asthma,
identifying the causes of immunologic abnormalities. The
ultimate goal was to restore the homeostatic self-regulation
of the body without involvement of medications. The
algorithm for the treatment of asthma was developed on
an individual basis, depending on the type of asthma and
accompanying disorders (if any) of other body organs and
systems (Solovyev, 2011).
Pulmonary rehabilitation programs are aimed at
recovering and improving the respiratory function through
a mechanical action on the more distal bronchial and
pharmacological branches. Each pulmonary rehabilitation
program is supposed to be a very important part of a
comprehensive treatment and can help to improve breathing
and decrease the incidence of musculoskeletal system
dysfunctions (Slader et al., 2006). In 2013, Carson et al.
published an analysis of 21 studies including 772 patients
with asthma, who were randomised to undertake physical
training or not. Physical training had to be undertaken for
at least 20 minutes, two times a week, over a minimum
period of four weeks. The authors’ conclusions were that
physical training can improve cardiopulmonary function
and may have positive effects on the health-related quality
of life in patients with asthma, benefits unrelated to the
effects on lung function. There was no evidence of adverse
effects caused by physical training on asthma symptoms.
The same review shows that physical training is well
tolerated by these patients. The intervention programmes
that produced these benefits included aerobic conditioning
using a treadmill, other aerobic exercises and swimming
(Carson et al., 2013). Another strategy used in improving
asthma symptoms was the association between physical
activity and the education program and breathing exercises
(Carson et al., 2013).
GINA mentions that there is little evidence to
recommend one form of physical activity over another,
but breathing exercises are useful supplements to
asthma pharmacotherapy (evidence B) (1). Also, regular
physical activity is recommended because of its general
health benefits (evidence A) and the improvement of
cardiopulmonary fitness, without a specific benefit on lung
function or asthma symptoms, except for swimming in
young people with asthma (evidence B). Information on
the patient is important in order to provide advice about
the prevention and management of exercise-induced
bronchoconstriction (evidence A) (1). Therefore, the
approach to the treatment of asthma was holistic and was
chosen for each patient individually in accordance with the
chosen strategic asthma treatment plan.
The components of holistic systemic therapy of asthma
comprised the regulated and officially approved pulmonary
rehabilitation methods and techniques, which included:
- education;
- chest physiotherapy;
- respiratory gymnastics;
- physical training;
- balneotherapy;
- climatotherapy;
- speleotherapy;
- sylvinite speleotherapy and chest cryomassage;
- halotherapy;
- spa therapy;
- others (acupuncture, with or without use of resonance
on biologically active points, homeopathy).
Education means the individual recommendations on
the way of life, diet, and nutrition (Milan et al., 2013). Each
education lesson should include the pathophysiology of
asthma, the importance of breathing exercises and physical
training, all possibilities of treatment. The physical
therapist offers materials about asthma and materials
describing exercises.
Chest physiotherapy focused on breathing exercises
and respiratory gymnastics (control breathing, thoracic
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expansion exercises, forced expiratory technique, autogenic
drainage, pursed lip breathing, diaphragmatic breathing,
effective cough training and elimination of upper chest
breathing) (Burianova et al., 2008). Buteyko is a specific
form of breathing therapy (actually breathing restraint)
that has been used in the management of asthma. Professor
Konstantin Pavlovich Buteyko (Russia) developed it about
50 years ago. His theory was that many “civilisationinduced diseases” are caused by deep breathing. Buteyko
therapy was developed as a way to reduce the depth of
respiration. Many studies have shown that the Buteyko
technique used in patients with asthma decreased the use
of medication and improved their clinical status (Hassan
et al., 2012; Cowie et al., 2008). A systematic review and
meta-analysis showed improvements in HRQoL from trials
of the Buteyko breathing technique or physiotherapistled breathing retraining. In asthma, breathing retraining
typically aims to eliminate over-breathing by developing
a slow, shallow, controlled breathing pattern (Holland et
al., 2012; Prem et al., 2013). Postural drainage consists of
making the patient assume a certain position in order to
facilitate the outflow of secretions from the different areas
of the lungs. The drainage is accompanied by shaking
vibrators, with compression of the chest wall and on
exhalation by the percussion of the chest wall by means
of the hand composed in the shape of cup, in order to
obtain the detachment of the bronchial secretions from the
walls, especially in chronic asthma (Slader et al., 2006).
Moreover, expanding the excursions of the diaphragm
allows to improve the mobility of the thoracic cage,
gaining elasticity through relaxation and lengthening of the
respiratory muscles intervening in breathing and thereby
promoting drainage of bronchial secretions (Slader et al.,
2006; Freitas et al., 2013).
Respiratory gymnastics represents a sequence of
operations performed to improve the breathing mode of
the lungs, which allows the exchange between oxygen
and carbon dioxide in the blood. Just breathing properly
provides a fair contribution of blood oxygen. Breathing
exercises give many benefits such as the increase of the
quantity of air blown into the lungs and the complete reexpansion of the same. It allows to recover gradually the
tone of respiratory muscles and it facilitates the removal
of phlegm from the bronchial tubes. Simple rhythmic
breathing exercises may help agitated patients to stop
hyperventilating and to use their inhaled therapy more
effectively (Slader et al., 2006).
Physical training - Exercise training remains a
cornerstone of pulmonary rehabilitation in patients with
asthma, because physical training programs improve
physical fitness, neuromuscular coordination and self
confidence, without deleterious effects on asthma control
(Chandratilleke et al., 2012). Although there were
insufficient data to pool results due to diverse reporting
tools, there was some evidence to suggest that physical
training may have positive effects on the health-related
quality of life (Pereira, 2014). Importantly, more recent
randomised controlled trials have also shown positive
effects of exercise training on asthma symptoms and
quality of life in adults with moderate-to-severe persistent
asthma (Mendes et al., 2010; Turner et al., 2011). The
choice of the type of exercise training depends on the
physiological requirements and goals of the individual
patient, as well as on the available equipment at the
rehabilitation centre where it is performed. Current
evidence suggests that ground walking exercise training,
Nordic walking exercise training, resistance training,
water-based exercise training, tai chi, and nonlinear
periodized exercise are all feasible and effective in patients
with asthma. These exercise training modalities can be
considered as part of a comprehensive, interdisciplinary
rehabilitation program (Andrianopoulos et al., 2014).
Physical training showed significant improvement in
maximum oxygen uptake, though no effects were observed
in other measures of pulmonary function. More research is
needed to understand the mechanisms by which physical
activity impacts asthma management (Pereira, 2014). The
multidisciplinary inpatient rehabilitation program proved
a significant short and long-term improvement in asthma
control, physical fitness and HRQoL in adult asthmatic
patients (Lingner et al., 2015). Exercise can be an important
trigger of symptoms in some individuals, even when their
asthma is otherwise well controlled. Exercise-induced
bronchospasm typically occurs 5-10 min after exercise,
with symptoms including breathlessness, wheeze, chest
tightness or cough. For individuals with exercise-induced
bronchospasm, GINA guidelines recommend pre-treatment
with a rapid-acting inhaled b2-agonist prior to exercise.
A gradual warm-up may also minimise exercise-induced
bronchospasm. Cardiopulmonary exercise testing may be
useful to detect exercise-induced bronchoconstriction prior
to commencing an exercise program (Holland et al., 2012).
The British Thoracic Society (BTS)/Scottish Intercollegiate
Guidelines Network (SIGN) asthma guideline draws
attention to exercise-induced asthma and precautions to
prevent this should be followed if appropriate (Bolton et
al., 2013).
Balneotherapy uses mineral waters that have special
properties in an attempt to treat patients with asthma.
Each water source has its own unique mineral properties
which is suited to treat this disorder. These waters contain
varying amounts of minerals that have proven health
benefits (Rassulova et al., 2007; McNamara et al., 2013).
In balneotherapy, mineral waters can be used internally
or externally. Balneotherapy uses subterranean products,
such as hot spring water, gases, muds, and climatic
factors, as therapeutic elements. Therapy is conducted
by combinations of hot spring water bathing, various
thermotherapies and hydrotherapies, exercises, drinking
waters, as a complex treatment. Hot spring water bathing
as a “bath cure” is the most fundamental modality of
balneotherapy, with repeated hyperthermic whole-body
immersion at a water temperature that is quite hot. In
this therapy, the direct effects of the physical factors of
bathing, such as hydrostatic pressure, buoyancy, and water
temperature, and the pharmacological properties of the hot
spring water constituents exert important actions on the
body. The complex therapeutic stimulation is repeatedly
applied during a long-term period of 2-4 weeks. These
therapeutic factors work to alter physiological functions
comprehensively and non-specifically (Rassulova et
al., 2007). The process of alteration is considered to
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Benefits of rehabilitation programs for the asthmatic patient
be mediated by the autonomic nervous, endocrine,
and immune systems, resulting in normalisation of
pathological functions and enhancement of the functional
capacities and self-healing potential of the organism. Most
physiological functions exhibit a circaseptan (about 7 days)
rhythm during the course of adaptation to the therapeutic
environment. The beneficial usefulness of balneotherapy
has been well demonstrated in patients with asthma. In
most cases, clinical symptoms were improved. Moreover,
basic studies showed immune and antioxidative defence
systems were ameliorated or enhanced (Andrianopoulos et
al., 2014). The significance of modern balneotherapy has
been increasingly emphasized, especially for the purposes
of preventive medicine and health promotion (Cowie et al.,
2008).
Climatotherapy - Alpine climatotherapy improves
the general status; patients with asthma manifest an
amelioration of ventilation and decreased responsiveness
of the bronchial tree by the end of alpine climatotherapy.
Favourable alterations in the immune parameters together
with appreciable stimulation of steroidogenesis in the
adrenals are discovered. Alpine climatotherapy produces
a favourable effect on the main mechanisms of disease
development and can be used on a wider basis for the
treatment of patients suffering from asthma. Maritime
climate also improves the clinical status of patients with
asthma (Schuh & Nowak, 2011; Massimo et al., 2014).
Speleotherapy in salt mines and caves - Speleotherapy
and halotherapy are used in the treatment of asthma with
different degrees of control. Long-time exposure to salt
therapy helps to strengthen the respiratory mucosa against
allergens and maintains proper hygiene over the whole
respiratory system. Home salt therapy is also available for
long term exposure in chronic respiratory diseases. Through
aerosol salt therapy and salty baths, the anti-inflammatory
and healing effects of salt therapy are highlighted. Rocksalt aerosol therapy is considered one of the most effective
methods of treatment of asthma (Beamon et al., 2006;
Rassulova et al., 2007; Munteanu et al., 2011; Lazarescu et
al., 2014a; Levchenko et al., 2014).
Sylvinite speleotherapy and chest cryomassage
- This combined method has shown its utility in the
rehabilitation of patients with asthma. It consists of the
application of microclimate sylvinite speleotherapy, the
main active factor of which is sylvinite - a rock formed
by the mutual germination of halite (sodium chloride)
and Silvina (potassium chloride), total average content
in salt layers 97-98%, a small percentage consisting of
magnesium salts (Aĭrapetova et al., 2011; Irapetova et al.,
2011). The distinctive feature of this method of treatment
is the possibility of integrated and consistent impact
on the patient’s organism of a sylvinite speleotherapy
microclimate, providing multivariate effects due to stable
temperature and humidity conditions, high air ionization,
temporary isolation of the patient from aggressive external
environment, elimination of allergens, and impact of
cryomassage, based on the abstraction of heat from the
body tissues with the aim of achieving a muscle relaxant,
anti-oedematous and, as a consequence, increased antiinflammatory, analgesic potency. The patient, on the
background of basic and symptomatic medication, spends
the first half of the day under the impact of climate sylvinite
speleotherapy, for 60-90 minutes daily; in the second half
of the day, the patient consistently undergoes the chest
cryomassage method: bags with the volume of 300 to 500
ml, which are cooled in the freezer at a temperature of
-21 degrees to -23 degrees. The technical results of this
proposed method are anti-inflammatory, broncholytic,
immune-correction effects that slow the progression of
the disease and improve the results of treatment, leading
to an improvement of the quality of life of patients with
longer remission of the disease, reducing the frequency of
relapses and decreasing drug load on the organism, as well
as the possibility of application of the method in patients
with concomitant diseases. The goal of the cryo treatment
is the achievement of a muscle relaxant, analgesic effect,
and the strengthening of the anti-inflammatory action.
The effect of cold on the organism is similar to the
action of glucocorticoids, which is accompanied by a
decrease of the content and activity of fat and biogenic
amines, reducing capillary permeability. The method of
treatment was applied with good results to patients with
exogenous allergic asthma as well as patients suffering
from endogenous non-allergic asthma (it reduced coughing
and shortness of breath, the need for inhaled bronchial
spasmolytics, it improved mucus discharge and normalised
respiratory function, with an immunomodulatory effect).
The improvement of the clinical status was paralleled by
changes in the psycho-emotional status of the patients.
The combined method of sylvinite speleotherapy and
cryomassage improves the well-being of patients, their
activity and mood. It also increases tolerance to physical
activity according to the 6-minute walking test (Aĭrapetova
et al., 2011; Irapetova et al., 2011).
Halotherapy is a mode of treatment in a controlled
air environment which simulates a natural salt cave
microclimate. The main curative factor is dry sodium
chloride aerosol with particles 2 to 5 mkm in size. Particle
density (0.5-9 mg/m3) varies with the type of the disease.
Other factors are the comfortable temperature-humidity
regime, the hypobacterial and allergen-free air environment
saturated with aeroions. It is used in the treatment of various
types of respiratory diseases, but it mainly improves the
clinical state of most of the patients with asthma. The
positive dynamics of flow-volume loop parameters and
the decrease in bronchial resistance measured by body
plethysmography are observed. The specificity of this
method is the low concentration and gradual administration
of dry sodium chloride aerosol (Chervinskaya, 2003;
Rassulova et al., 2007). In our country, this mode of
treatment was applied to patients with chronic allergic
asthma and infectious-inflammatory pathologies. The data
acquired also proved the halo-therapeutic effect causing
a reduction of body sensitiveness in patients with asthma
(Lazarescu et al., 2014 b).
Spa treatment is commonly used for people who
have chronic respiratory diseases, with acute remitting
process, and mostly if the disease is in remission. The main
factors are resort balneotherapy, climatotherapy, mud and
physiotherapy. Spa treatment is especially useful when
administered in a health facility (Tanizaki, 2007; Ochiuz
& Popovici, 2014). One of the spa treatment methods that
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Rodica Traistaru et al.
has shown its utility in the treatment of asthma patients
(especially for patients with allergic asthma) uses the
effects of radon and thermal therapy. The sanatorium in
which treatment is performed must be in a forest-steppe
climate, dominated by coniferous trees, combined with
healing radon springs. Radon increases the blood levels
of the absolute and relative numbers of T-lymphocytes,
reducing the number of eosinophils, which increases
immune-competent body defense. Radon baths and
inhalation are also useful in case of inflammation of the
respiratory tract. Radon and thermal therapy are performed
once a week. All subjects enter a hot bathroom with a high
concentration of radon, and nasal inhalation of vapours
from a hot spring is performed for 40 min once a day
under conditions of high humidity. Radon and thermal
therapy improves the pulmonary function of asthmatics by
increasing the reduced activities of antioxidant enzymes.
Spa therapy methods are effective in asthma by improving
the ventilator function, subjective and objective symptoms,
and the suppressed function of adrenocortical glands. Spa
treatment also decreases airway inflammation, especially
in patients who present a large number of inflammatory
cells such as lymphocytes, neutrophils and eosinophils. Spa
treatment has also shown its utility in uncontrolled asthma
patients (Sokolova et al., 2007; Kamimura, 2014). Complex
spa therapy (swimming training in a hot spring pool, fango
therapy and inhalation of iodine salt solution) also has a
beneficial effect on psychological factors in patients with
asthma (Sokolova et al., 2007). During the spa and resortbased treatment of asthma therapy, hypoxic interval training
and enteral oxygen therapy are performed. This combined
application of hypoxytherapy and oxygen therapy can also
be used. During spa treatment, an improvement of oxygen
supply to various organs at all stages of mass transfer and
an enhancement of oxygen consumption by the tissues
occur. These effects promote the normalisation of the
respiratory system function, improve the characteristics
of the exhaled air condensate and the state of pro-oxidant
and anti-oxidant systems. This confirms the high efficacy
of the combined therapeutic modality for the treatment of
patients with asthma (Sokolova et al., 2007).
Conclusions
1. The pharmacological management of asthma does
not eliminate the cause of the disease; after a temporary
physical alleviation, the next acute exacerbation of asthma
is inevitable, becoming more and more severe with each
episode. In a few years of treatment with medications,
patients with asthma become disabled to different degrees.
2. There is a real need for additional non-drug remedies
that can influence the basic clinical manifestations of
the disease, to improve the efficiency of treatment. The
main goals of the rehabilitation treatment are to restore
the homeostatic self-regulation of the body without the
involvement of too many medications, to improve the
clinical as well as the psycho-emotional status of patients,
and to promote self-management.
3. Guided self-management for asthma that requires
important aspects (education, joint goal setting, a
personalized written action plan, self-monitoring of key
symptoms, and regular review of asthma control, treatment
and skills by a healthcare professional) is highly effective
and considered a cornerstone of modern asthma care.
4. All clinicians and healthcare professionals involved
in complex asthma care should make sure that any selfmanagement training provided meets the guideline
requirements for people with this complex respiratory
disorder.
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